Provider Demographics
NPI:1073806717
Name:HORMONE REPLACEMENT CLILNIC
Entity Type:Organization
Organization Name:HORMONE REPLACEMENT CLILNIC
Other - Org Name:HRC MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:R
Authorized Official - Last Name:IVEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-595-5363
Mailing Address - Street 1:808 LANDMARK DR SUITE 116
Mailing Address - Street 2:SUITE 116
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061
Mailing Address - Country:US
Mailing Address - Phone:410-595-5363
Mailing Address - Fax:410-595-5367
Practice Address - Street 1:808 LANDMARK DR
Practice Address - Street 2:SUITE 116
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-4983
Practice Address - Country:US
Practice Address - Phone:410-595-5363
Practice Address - Fax:410-595-5367
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-26
Last Update Date:2011-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD005740174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty